Health inspection·September 29, 2023

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure assessments accurately reflected the resident's status for 1 of 6 residents (Resident #6) reviewed for accuracy of assessments. Residents Affected - Few The facility failed to ensure Resident #6's MDS accurately reflected the resident hearing loss. This failure could place residents at risk for not receiving care and services to meet their physical needs and promote feelings of well-being and quality of life. The findings include: Record review of Resident #6's, undated, admission Record, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #6 had diagnoses which included: unspecified hearing loss unspecified ear, speech, and language development delay due to hearing loss, cerebral infarction (stroke), and hemiplegia non dominant side (paralysis on one side of the body). Record review of Resident #6's Annual MDS, dated [DATE], Section B revealed the resident was able to hear adequately. Record review of the resident's care plan revealed the resident had a communication problem related to a hearing deficit. The problem start date was 4/7/20, and a revision date of 9/23/23. During an observation and interview on 09/26/23 at 12:03 PM revealed Resident #6 communicated by typing on his laptop computer that he could not hear, and he did not use hearing aids. He could not speak clearly, and he preferred to use the laptop to communicate his needs. In an interview on 09/28/2023 at 10:40 AM, the MDS Coordinator stated she did not have a facility policy for completing MDS assessments. She stated the admission MDS for Resident #6 was not accurately descriptive of his hearing status. She stated she completed the assessment and was responsible for all MDS assessments in the facility and she failed to document Resident #6's Section B accurately because she was in a hurry and made a mistake. She stated she followed the guidelines of the RAI Manual to complete assessments. She stated it was her expectation the MDS be documented to accurately reflect the resident's status. She also stated failure to not complete the MDS accurately could result in the resident not receiving needed care and services. She stated she would make a correction to the MDS. Interview with the DON on 9/28/23, at 11:00 AM revealed the MDS Coordinator was responsible for accurately completing the MDS. She stated failure to accurately document the resident's status in the Page 1 of 5 455574 455574 09/29/2023 Avir at Weatherford 521 W 7th St Weatherford, TX 76086

F 0641 MDS could result in the resident not receiving needed care Level of Harm - Minimal harm or potential for actual harm Record review of the RAI Manual section B, dated 10/2019, revealed in part: Residents Affected - Few This section is intended to document the resident's ability to hear (with assistive hearing devices if used) understand and communicate with others and whether the resident experiences visual limitations or difficulties, related to diseases common in aged persons. 455574 Page 2 of 5 455574 09/29/2023 Avir at Weatherford 521 W 7th St Weatherford, TX 76086

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchens reviewed. Residents Affected - Many 1. The facility failed to ensure the floors weren't soiled with food particles and grease beneath the appliances and stainless-steel shelf units throughout the kitchen. 2. The facility failed to ensure two of two refrigerators did not have what appeared to be spilled milk, dried liquids, and food crumbs on the bottom shelf. These failures could place residents at risk for foodborne illness and a decline in health status. The findings include: Observations on 09/26/2023 at 9:40 AM, during the initial tour of the facility kitchen, revealed the following: - the floor was soiled with food debris and grease beneath shelves and appliances throughout the kitchen. - 2 of 2 refrigerators had what appeared to be spilled milk, dried liquids, and food crumbs on the bottom shelf. Observations on 09/26/2023 at 9:50 AM revealed daily cleaning logs, dated September 2023, used for all the kitchen cleaning duties revealed all cleaning duties for the morning had been completed and initialed by the kitchen staff who completed the cleaning. In an interview on 09/28/2023 at 10:40 a.m. with the Dietary Manager stated, her kitchen staff followed a cleaning schedule, but someone must have set a glass of milk on an open box, and it spilled and was not cleaned. She further stated, it's important that the kitchen counters, refrigerators, freezers, and equipment be clean to prevent foodborne illness. In an interview on 09/29/2023 at 3:35 p.m. the DON stated, her expectation was for the dietary department to follow the dietary department cleaning policy. In an interview on 09/29/2023 at 3:40 p.m. the Regional Consultant stated, his expectation was for the dietary department to follow their cleaning schedule per dietary department policy. Record review of the facility's Policy titled Refrigerators, Coolers and Freezers dated, October 1, 2018, revealed [in-part]: The facility will maintain refrigerators, coolers and freezers in a clean and sanitary manner to minimize the risk of food hazards. Refrigerators, coolers and freezers will be kept clean on a daily basis and will be thoroughly cleaned every month or more often as needed . 455574 Page 3 of 5 455574 09/29/2023 Avir at Weatherford 521 W 7th St Weatherford, TX 76086

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure each resident had the right to a safe, clean, sanitary, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely on one of six hallways (Hallway 200) and the smoking area for areas reviewed for environment. 1. The facility failed to ensure Hallway 200 did not have a strong odor of urine. 2. The facility failed to ensure the smoking area did not have a foul odor with a large, uncovered bin filled with dirty laundry and a large, uncovered bin filled with trash within the smoking area. These failures could place residents at risk for a diminished quality of life and a diminished clean, homelike environment. The findings include: 1. In an observation during the initial tour on 09/26/23 at 11:24 AM, the entire Hallway 200 had a strong odor of urine. In an observation on 09/27/23 at 9:30 AM, Hallway 200 had a strong odor of urine which became stronger towards the end of the hallway. In an observation and interview on 09/28/23 at 10:50 AM, Hallway 200 had a strong odor of urine and progressively got stronger towards the end of the hallway. LVN A stated the hallway smelled at times but did not smell of urine to her. She stated the smell was from a resident who had a foul bowel movement. In an interview on 09/28/23 at 11:30 PM, Housekeeper B stated Hallway 200 smelled of urine most of the time. She said she believed it was coming from the resident in room [ROOM NUMBER]. She said when the resident left his room, she cleaned the resident's mattress and floors. In an observation and attempted interview on 09/28/23 at 11:35 PM, Resident #29 refused to be interviewed. His room was clean but smelled of urine. In an interview on 09/28/23 at 1:32 PM, the Maintenance Director stated he was aware of the odor on hallway 200. He said he thought it was coming from room [ROOM NUMBER]. He said he attempted to get rid of the smell and replaced the toilet, used charcoal and enzymes, and painted the walls, but it did not help. He did not think the resident was urinating on the floor. In an interview on 09/28/23 at 1:48 PM, Resident #61 who resided on the hallway said the hallway smelled most of the time and she kept her door closed due to odor. In an interview on 09/28/23 at 1:49 PM, Resident #54 stated she visits a friend on Hallway 200 and there was always a strong odor in the hallway. She said that was the reason why most of the residents on the hallway keep their door closed. 455574 Page 4 of 5 455574 09/29/2023 Avir at Weatherford 521 W 7th St Weatherford, TX 76086

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 09/28/23 at 3:45 PM, Resident #22 who resided on Hallway 200 said the smell was horrible at times. She kept her door closed due to the smell. 2. In an observation and interview of the smoking area on 09/28/23 at 1:48 PM, there were 6 residents smoking. Observed within the smoking area, there was a large, uncovered bin filled with bagged dirty laundry and there was a large, uncovered bin filled with mostly bagged trash that smelled. A staff member came into the smoking area and put 4 pizza boxes in the trash. In an interview with Resident #54 and Resident #61, who were sitting on the other side of the smoking area, said the bins were always there and they smelled, it was why they sat away from them. In an interview on 09/28/23 at 2:15 PM, the Medical Records Supervisor said she was filling in for the Housekeeping Supervisor and the bins were placed in the smoking area during COVID. It was where staff brought dirty laundry to be picked up by laundry and trash to be picked up by maintenance. In an interview on 09/28/23 at 2:27 PM, the Maintenance Director said the bins were placed in the smoking area during COVID. It was where staff brought dirty laundry to be picked up by laundry and trash to be picked up my maintenance. He said a negative outcome would be it would attract flies and pests. He said they put out bait for pests. The Maintenance Director stated there was no facility policy. The Administrator was not available for interview during the survey. 455574 Page 5 of 5